Endocrine Abstracts

Introduction: In many lower-middle income countries (LMICs), poverty, insufficient infrastructure and lack of universal health coverage affect type 1 diabetes (T1D) outcomes. Limited insulin and unavailability of blood glucose monitoring supplies contribute to poor glycaemic control and T1D complications that adversely affect mortality and morbidity. Laos is a LMIC in Southeast Asia (SEA) with a population of 7.3 million. Its GDP per capita is USD 2,534 of which only 2.5% represent government healthcare spend and does not provide for diabetes treatment. No known Laotian had previously survived T1D. Since 2016, a programme started by a non-government organisation (NGO), Action4diabetes (A4D), has been providing insulin, blood glucose monitoring kits, HbA1c tests and emergency hospital funds for Laotian children and young people (CYP) with T1D, including education and training for healthcare professionals, in partnership with the Laos government. We report the first data on demographics and clinical outcomes of Laotians with T1D enrolled to-date.

Methods: Data from 2016 to 2021 were reviewed including gender, age and presentation at diagnosis, HbA1c and hospital admissions.

Results: There were 53 CYP (31 male; 58%) diagnosed with T1D at a mean (SD) age of 10.4 (4.2) y, of whom 31 CYP (58%) presented in DKA at diagnosis. Forty-four of the 53 CYP (83%), currently aged 12.9 (4.8)y, remain on active follow-up (24 male; 55%), and have had T1D for 2.4 (2.3)y. From 2016 to 2021, mean HbA1c was 9.0% (75 mmol/mol) overall, and 8.5% (69 mmol/mol), 8.1% (65), 9.1% (76), 9.8% (84), and 7.7% (61) among the CYP aged 0-5y, 6-10y, 11-15y, 16-20y, and 21-25y, respectively. There were a total of 39 hospital re-admissions for DKA (0.3/person/y), 9 re-admissions for severe hypoglycaemia (0.07), and 9 re-admissions for other reasons (0.07).

Conclusions: This is the first report on T1D care in Laos spanning 2016 to 2021. There is a need for more global efforts to improve T1D care outcomes in Laos and other LMICs in SEA. Close partnership between NGOs and governments has enormous potential in developing sustainable and locally owned solutions for improving diabetes care in CYP with T1D in these LMIC.